PERSONAL INFORMATION

Name - Last* First* Middle Initial*

Date of Birth (MM/DD/YYYY)*

Home Address
            Street*    
            City*   State*   Zip*

Father - Name Occupation

Mother - Name Occupation

Home Phone Number*

Email Address

ACADEMIC INFORMATION

High School*

Date of Graduation (MM/YYYY)*

Class Rank/Number in Class (#/#)

SAT - Date Taken (MM/YYYY) Total Score Verbal Math

Have you applied to the NCAA Clearinghouse?  Yes  No
   (What is the NCAA Clearinghouse?)

Have you applied to Mansfield University? Yes  No

Academic Program Desired at Mansfield University

ATHLETIC INFORMATION

High School Coach*

Coach's Phone Number

Summer Team

Summer Coach

Height    Weight

Years as a Varsity Starter (including senior year)

Events (put primary event first)

60-yard Dash Time

Mansfield University Alumni/Students You Know

Other Varsity Sports Played

OTHER INFORMATION

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